Provider Demographics
NPI:1417711060
Name:CAMPANARO, CAMILLE E (OTD OTR/L)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:E
Last Name:CAMPANARO
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BANKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9768
Mailing Address - Country:US
Mailing Address - Phone:949-413-1511
Mailing Address - Fax:
Practice Address - Street 1:1871 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1493
Practice Address - Country:US
Practice Address - Phone:541-670-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR429255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist